Online Form - Hazard Report Form - Section Two

Please complete Section Two of the Hazard Reporting Form. A copy of this report will also be emailed to Safety@swek.wa.gov.au immediately after completion. If you have any questions, please contact Safety & Wellbeing Officer Lynsey Gannon on 08 9168 4100 or Lynsey.Gannon@swek.wa.gov.au

Supervisors, please complete the following Section

Supervisor Name *

Supervisor Email *

I have investigated the above hazard and make the following observations *

Please type in your full name. By typing in your name, you are agreeing that the above information is correct. *

Date *

Type the code from the image:

Get Audio Code

Type the code from the image